Commercial Plans → Employers
Employers across the nation are making the decision to cover the National Diabetes Prevention Program (National DPP) lifestyle change program for various reasons, including the fact that it can: (1) decrease the cost of providing health care to employees over time; (2) improve the health of at-risk employees by preventing or delaying the onset of type 2 diabetes; (3) engage employees in preventive care practices, resulting in higher productivity; and (4) provide a wellness benefit for employee retention.
Employers have also cited additional benefits from offering the National DPP, including positive behavioral health modifications, a focus on population health improvement, increasing employee engagement, and increasing employee satisfaction. Employee health can improve through reducing blood pressure, cholesterol levels, and weight, and increasing sleep quality by decreasing sleep apnea (see Evidence ).
Note: An employer should never store individual employee information in the same location as employee health information. Many challenges with health information privacy can be eliminated by contracting with a health organization to provide screenings or by holding health-related classes off-site. Employers may not discriminate against an employee based on genetic information, including risk of diabetes.
About Employer-Sponsored Health Insurance
Employers can provide health insurance coverage for their employees through a variety of methods, but for the purposes of this toolkit, we distinguish between (1) fully insured; and (2) self-insured employers.
Fully insured employers pay an insurance company to assume financial risk for their employees; i.e., the employees’ health care claims are paid by the insurance company.
Self-insured employers accept financial risk and administer their own health insurance plan; i.e., the employees’ health care claims are paid by the employer.
This distinction of fully insured vs. self-insured is important, because the decision to offer the National DPP lifestyle change program and how it is delivered may vary depending on the employers’ method of insurance coverage.
Fully insured employers work with a commercial health insurance plan (with assistance from a broker or benefit consultant) to decide whether to cover the program for their employees or a subset of their employees.
Self-insured employers decide themselves (with assistance from a broker or benefit consultant) whether to cover the National DPP lifestyle change program for their employees or a subset of their employees.
Whether an employer is fully insured or self-insured, their insurance coverage is “commercial.” As such, all the subsections within the Commercial Plan section of this toolkit can be applied to both fully insured and self-insured employers, unless where noted.
Covering the National DPP Lifestyle Change Program
Employers can organize and administer the National DPP lifestyle change program in multiple ways. It can be provided as a health benefit under the insurance plan; or many employers provide a wellness program for their employees that is designed to help employees eat better, improve fitness, lose weight, or simply improve overall health. The National DPP lifestyle change program shares these common goals and is an evidence-based program that has proven effective for employees at risk for type 2 diabetes. It would be an effective addition to an employer’s wellness program.
Various options for program delivery, coverage method, contracting parties, and contract type can be combined to create a program structure that best fits the employer organization and its employees. Many of the options that make up the program framework can be seen in the table below.
*Regardless of the delivery method—onsite, online, or in the community—the organization should be recognized by the CDC’s Diabetes Prevention Recognition Program (DPRP). For more information about the DPRP, please see Implementing a Lifestyle Change Program and Standards for CDC Recognition.
Examples of Employers Covering the National DPP Lifestyle Change Program
The Minnesota Health Action Group convenes employers and other stakeholders to improve the value of health and health care. It recently shared some of the experiences of its partner employers that have implemented the National DPP lifestyle change program. These experiences highlight important considerations for employers deciding how to implement the program.
Employee demand – If a small employer, are there enough employees to fill an onsite class? Other available options, in addition to onsite classes, include offering an online program, combining with a community class, or partnering with another local employer.
Online experience – Are employees comfortable using technology and able to go online to check in? Can the employees access the program at work on company time?
Team-learning approach – Do employees prefer face-to-face learning? Is it likely that a more personalized, group experience will be successful? Is the program available through community classes from a local hospital, YMCA, or extension program?
Payment options – Employers may request to have the National DPP lifestyle change program covered by health insurance benefits. If it is not a covered benefit, other options for financing include using discretionary dollars, training budgets, or other means to pay for the program. Some employers may ask the employee to pay a portion of the fee, which can enhance personal accountability and the likelihood of successful program completion.
One employer offers the National DPP lifestyle change program across campuses in North America and has enrolled over 2,400 individuals. It offers an onsite program at four locations and online, and community-partner programs at many more. Results have been positive, with almost 40% of Canadian participants achieving at least 5% weight loss. (Weight loss statistics for the U.S. population were not available).
Costco started offering the program as a pilot, rolling it out nationwide after finding that employee engagement and retention rates in the program were high. As of May 2016, about 10,000 Costco employees have participated in online delivery of the program. The program is a covered medical benefit for employees and spouses. Costco encouraged initial participation by conducting a regional competition to complete a “One-Minute Challenge,” a computer-based tool meant to identify potentially eligible individuals. At some sites, 50‒60% of employees participated in this challenge.
This document tells the stories of five employers offering the National DPP lifestyle change program as a covered health or wellness benefit.
State and Local Public Employee Coverage
One sector of employers that have implemented the National DPP lifestyle change program successfully are state employee health plans. States that offer the program are able to reach a large number of members, increasing their options for how to deliver the program.
Washington State started offering the National DPP lifestyle change program to state employees in 2014. It identifies eligible enrollees through worksite screening events where employees can enroll in the program (some sites allow spouses to also enroll). Classes are held onsite and in the community when the number of eligible employees is not large enough to host an onsite class. It is exploring the use of online delivery in future years. Washington has seen positive outcomes; 40% of enrollees who completed the course also achieved at least 5% weight loss.
The New York City Department of Labor has offered the National DPP lifestyle change program since 2015, when it received funding to establish in-person and online pilots at the worksite. New York City has an 80% retention rate, and program participants have reported positive experiences and high levels of engagement. Current demand for the program exceeds supply, and adoption of the program has expanded to other city agencies. The Department of Labor has also leveraged partnerships with employee unions and a university to support data collection and analysis. Although the program is not a covered benefit, it is offered at no cost to employees on a first-come, first-served basis. The department is seeking to secure insurance coverage in the future for program expansion.
California’s Public Employees’ Retirement System (CalPERS) began implementing the National DPP for all CalPERS members, through all contracted health plans, as of January 2017.
The Kentucky Employees’ Health Plan has implemented the National DPP lifestyle change program, and examples of its experience are included in subsections of the Commercial Plans section.
This document tells the stories of three states offering the National DPP lifestyle change program as a covered benefit for state employees.